Pseudotumor cerebral secundario a sinusitis esfenoidal / Pseudotumour cerebri secondary to sphenoid sinusitis

No disponible

Relación entre factores de riesgo y necesidad de reanimación en la sala de partos / Relationship between risk factors and need for delivery room resuscitation

Objetivo: Estudio retrospectivo del modo de reanimación realizada en sala de partos y su relación con diferentes factores de riesgo, de todos los recién nacidos (RN) que precisaron reanimación, nacidos de enero a diciembre de 2004 en el Hospital Clínico Universitario (HCU) de Valladolid. Resultados: De los 1.364 RN en el período de estudio, 96 (7,03%) precisaron ventilación con presión positiva. De estos en el 6,89% mediante bolsa y mascarilla, y en el 0,73% mediante intubación traqueal. El líquido amniótico meconial y la prematuridad extrema fueron los factores con riesgo más alto de necesitar intubación traqueal en paritorio. Los niños nacidos mediante cesárea urgente o los procedentes de un parto vaginal mediante ventosa precisaron reanimación en el 14,12 y el 12% respectivamente La ventosa fue el parto vaginal instrumental con mayor riesgo. En un 20% de los RN que precisaron reanimación no se encontró ningún factor de riesgo, si bien todos respondieron a la ventilación con bolsa y mascarilla. En 6 niños el test de Apgar al minuto fue = 4 ó = 7. Conclusión: Los recién nacidos con riesgo bajo o moderado que precisaron ventilación con presión positiva al nacimiento respondieron adecuadamente a la ventilación con bolsa y mascarilla. La prematuridad extrema y el líquido amniótico meconial fueron los factores de riesgo en los que con mayor frecuencia fue necesaria la intubación endotraqueal. Conocer el impacto sobre el feto de los diferentes factores de riesgo ayuda a optimizar la asistencia al recién nacido en sala de partos (AU)

Objetive: Retrospective study of the resuscitation practice at birth and the relationship with level of risk of different risk factors, of babies who required resuscitation at birth, born between january and december 2004 at HCU of Valladolid. Results: 1,364 infants were born in our hospital in 2004, of these 96 needed positive pressure ventilation. The proportion of babies receiving bag and mask ventilation was 6,89%, and intubation was undertaken in 0.73%. Infants with meconium-stained fluid and very preterm infants had a high risk of traqueal intubation. Infants born by emergency C-section and vacuum delivery need resuscitation in 14,12% and 12% respectively. Vacuum delivery was the instrumental delivery with high risk than others. In 6 infants the Apgar test was = 4 ó = 7. Conclusion: The bag and mask ventilation was an useful method in resuscitation of infants with low or moderate levels of risk factors. In very preterm infants or in cases of meconium-stained fluid there were a high incidence of traqueal intubation Assignment of level of risk in a delivery, provides a safe means to take care of the newborn in the delivery room in the best conditions (AU)

Candidiasis cerebral en un recién nacido / Cerebral candidiasis in a neonate

No disponible

[The tumor necrosis factor system and leptin in coeliac disease]. / Sistema factor de necrosis tumoral y leptina en la enfermedad celíaca.

OBJECTIVE: Patients with coeliac disease (CD) present anorexia and malnutrition. Leptin is a significant anorexigenic factor, with a close relationship to the body mass index. The aims of this study were to asses serum leptin levels in CD and their possible influence on appetite, as well as to compare and relate leptin with tumor necrosis factor (TNF) activity, which has similar functions. METHODS: Leptin and TNF receptor-1 (TNFr-1) were measured by enzyme-linked immunosorbent assay. Sixty-five serum samples from patients with CD (28 boys and 37 girls) were analyzed. In all patients, small bowel biopsy and anti-endomysium determination were performed simultaneously. Twenty-nine patients presented active CD and 36 were in remission. RESULTS: Leptin concentrations were reduced in active CD (p = 0.002). In patients in remission, leptin was related to the body mass index (p = 0.001), but this correlation was not found during the active phase of the disease. Contrary to normal differences between sexes, in active CD leptin levels were similar in boys and girls. TNFr-1 was found in all serum samples and levels were statistically higher in patients with active CD (p = 0.0003), suggesting that the TNF system is activated in this disease. CONCLUSIONS: Leptin concentrations were reduced in active CD, but we did not find the usual positive correlation with body mass index and higher concentrations in girls. These results suggest that leptin does not contribute to anorexia and failure to thrive in patients with CD; in contrast, the TNF system might be involved.

Sistema factor de necrosis tumoral y leptina en la enfermedad celíaca / The tumor necrosis factor system and leptin in coeliac disease

Objetivo: Los enfermos celíacos presentan malnutrición y una gran anorexia. La leptina es un importante factor anorexígeno estrechamente relacionado con el índice de masa corporal (IMC). El objetivo fue estudiar la leptina sérica en la enfermedad celíaca y su posible acción sobre el apetito, compararla y relacionarla con el factor de necrosis tumoral (TNF), que tiene funciones similares. Métodos: La leptina y el receptor I de TNF (TNF-R-I) se midieron mediante enzimoinmunoanálisis (ELISA). Se analizaron 65 sueros de enfermos celíacos (28 varones y 37 mujeres). En todos los casos se practicó simultáneamente biopsia intestinal y se determinaron anticuerpos antiendomisio. Estaban en actividad 29 casos y 36 en remisión. Resultados: Los valores de leptina estaban disminuidos en la fase de actividad de la enfermedad celíaca (p 0,002), lo que no apoya su participación sobre la anorexia y la desnutrición del paciente celíaco. Durante la remisión de la enfermedad celíaca la leptina se relaciona con el IMC (p 0,001), pero en la fase activa se rompe esta relación habitual. En la fase aguda también se rompe la diferencia entre sexos, y son similares los valores en varones y mujeres. El TNF-R-I se detectó en todos los sueros y mostró una elevación significativa durante la fase aguda (p 0,0003) lo que parece indicar una activación del sistema TNF en la enfermedad celíaca. Conclusiones: La leptina está disminuida durante la fase activa de la enfermedad, y se pierde su habitual correlación con el IMC y el sexo femenino. Los resultados señalan que no participa en la anorexia y la desnutrición de la enfermedad celíaca y, sin embargo, sí podría hacerlo el sistema TNF (AU)

[Value of serological markers in the diagnosis of celiac disease. A proposed protocol]. / Valor de los marcadores serológicos en el diagnóstico de la enfermedad celíaca. Propuesta de un protocolo.

AIM: In recent years, the high frequency of atypical cases of celiac disease (CD) and of forms of this disease with minor symptoms has prompted the search for analytical markers that may support indications for intestinal biopsy. The commonest tests are those for serum class IgG and IgA antigliadin antibodies (IgG-AGA, IgA-AGA) and IgA antiendomysial antibodies (IgA-EmA). METHODS: We report our 10 year experience of studying AGA in 1,075 serum samples from patients with CD and IgA-EmA in 534 samples. The serological markers were compared with 152 intestinal biopsies performed simultaneously with the other tests. RESULTS: In patients with severe intestinal atrophy the sensitivity of IgA-AGA (91%) and IgA-EmA (94%) was high. IgA-EmA and the latter showed the highest positive (88%) and negative (97%) predictive values. In all patients, IgA-EmA positivity coincided with alterations in the biopsy. Determination of IgA-EmA was also the most efficient marker for monitoring the gluten free diet phase. However, in patients in whom minimal histological changes were found in the intestinal mucosa, none of the markers was sufficiently accurate. RESULTS: IgA- EmA antibodies are the most accurate serological marker of CD. In view of these results and the estimated prevalence of the disease, protocols for the use of serological markers are proposed for the differential diagnosis of malabsorption symptoms, for use in patients at low and high risk of CD and for the followup of those with a diagnosis of CD.